The key factors driving successful improvement in primary care : a mixed methods investigation of the determinants of quality improvement success in Aotearoa New Zealand : a thesis with publication presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy, Massey University, Palmerston North, Aotearoa New Zealand

Simple item page
dc.confidentialEmbargo : No
dc.contributor.advisorJayamaha, Nihal
dc.contributor.authorCullen, Jane
dc.date.accessioned2024-07-08T00:58:39Z
dc.date.available2024-07-08T00:58:39Z
dc.date.issued2023-11-30
dc.description.abstractPrimary care is where the population receives most of their health care and where successful quality improvement (QI) can have the biggest impact on health, wellbeing, equity, and health system performance. A better understanding of the factors that influence QI in primary care is urgently needed to support a high-performing primary healthcare system. Most prior studies into the determinants of effective QI have focused on secondary care organisations and large-scale collaborative efforts. Primary care services such as general practice present a different set of challenges. Various key contextual factors have been identified in the literature, but few studies explain how they relate to each other and QI success. This study sought to answer the following questions: 1. What are the contextual factors influencing primary care improvement interventions? 2. How do the contextual factors, improvement content (topic and planned changes) and the implementation process influence each other and the improvement outcomes in primary care? 3. How applicable for primary care assessment is the Model for Understanding Success in Quality (MUSIQ), a tool for assessing modifiable contextual factors developed in secondary care? This research was an explanatory sequential mixed methods study based in the Aotearoa, New Zealand (NZ) primary care setting of general practice and Primary Health Organisations (PHOs). Amulti-case mixed methods approach was followed in the first stage. Mainly qualitative data were collected from primary care interviews guided by the Consolidated Framework for Implementation Research (CFIR). This was compared with quantitative data from the MUSIQ survey. The second stage consisted of a national survey where emerging theory was tested by partial least squares structural equation modelling (PLS-SEM). The findings revealed that most teams did not use formal QI methods, instead relying on their people-centred relationship skills and networks to drive QI via distributed leadership. Teams were intrinsically motivated by community and patient need and drew on strengths developed within the complexity and uncertainty of the primary care settings to drive QI. The collaborative skills which are increasingly required in the modern primary care setting support the shared social processes of sensemaking for enacting change. The key success factors driving QI in primary care are identified and how they relate to each other explained. A primary care adaptation of MUSIQ has been proposed that may aid improvement practitioners and researchers to assess primary care contexts. The key strengths should be developed and supported across primary care services and capability, capacity and resources supported centrally to increase the ability of primary care to improve services more easily and effectively.en
dc.identifier.urihttps://mro.massey.ac.nz/handle/10179/70107
dc.publisherMassey Universityen
dc.rightsThe Authoren
dc.subjectPrimary health careen
dc.subjectHealth services administrationen
dc.subjectMedical careen
dc.subjectQuality controlen
dc.subjectTotal quality managementen
dc.subjectNew Zealanden
dc.subjectquality improvementen
dc.subjectimplementationen
dc.subjectcase studyen
dc.subjectpartial least squares structural equation modelingen
dc.subjectdistributed leadershipen
dc.subjectgeneral practiceen
dc.subjectnetwork relationshipsen
dc.subjectsensemakingen
dc.subjectlearning climateen
dc.subject.anzsrc350715 Quality managementen
dc.subject.anzsrc401006 Systems engineeringen
dc.titleThe key factors driving successful improvement in primary care : a mixed methods investigation of the determinants of quality improvement success in Aotearoa New Zealand : a thesis with publication presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy, Massey University, Palmerston North, Aotearoa New Zealanden
thesis.degree.disciplineQuality Systems
thesis.degree.nameDoctor of Philosophy
thesis.description.doctoral-citation-abridgedJane Cullen used sequential explanatory mixed-method research to examine primary care quality improvement implementation. Her research identified the key factors driving primary care improvement and provides guidance for primary care strengths-based improvement. She has developed a model for a successful primary care improvement and adapted a contextual assessment tool for use in primary care.
thesis.description.doctoral-citation-longContextual factors and the relationship between the context, intervention and implementation process are thought to drive variable healthcare quality improvement outcomes. Primary care improvement implementation is under researched yet is the healthcare sector people engage with most frequently. Jane Cullen examined this topic via two-stage explanatory mixed methods research: a six case multi-case comparison study, and a national survey analysed by partial least squares structural equation modelling. Jane identified the key factors driving primary care improvement, developed a model and guidance for successful primary care strengths-based improvement, and adapted a contextual assessment tool for use in primary care.
thesis.description.name-pronounciationJane Cull-en
Files
Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
CullenPhDThesis.pdf
Size:
6.58 MB
Format:
Adobe Portable Document Format
Description:
Download
Collections
Theses and Dissertations